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• <br />o <br />00 <br />0= <br />0= <br />o= <br />ao <br />008083 <br />i'Wjy,‘ FLORIDA 11ORKEIVO PENSATrN <br />JOWT LPIDERNRFTNG ASSOCIAI ON, INC. <br />INSURER: FLORIDA W.C. JUA <br />1. <br />INSURED: <br />GIVING KIDZ A CHANCE INC <br />333 17TH STREET STE 0 <br />VERO BEACH FL 32960 <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />INFORMATION PAGE WC 00 00 01 ( A) <br />POLICY NUMBER: (6FR13UB-7D75634-1 -15 ) <br />RENEWAL OF (6FR13UB-7D75634-1-14) <br />NCCI CO CODE: 80179 <br />PRODUCER: <br />VERO INSURANCE INC DBA <br />3339 CARDINAL DR <br />VERO BEACH FL 32963 <br />Insured Is a A CORPORATION <br />Other work places and Identification numbers are shown in the schedule(s) attached. <br />2. The policy period is from 06-27-15 to 06-27-16 12:01 A.M. at the insured's mailing address. <br />3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers <br />Compensation Law of the state(s) Ilsted here: <br />FL <br />B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work In each state Ilsted In <br />item 3.A. The limits of our liability under Part Two are: <br />Bodily Injury by Accident: $ <br />Bodily Injury by Disease: $ <br />Bodily Injury by Disease: $ <br />500000 Each Accident <br />500000 Policy Limit <br />500000 Each Employee <br />C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: <br />SEE ENDORSEMENT FWCJUA 03 01 <br />D. This policy includes these endorsements and schedules: <br />SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE <br />4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating <br />Plans. All required information is subject to verification and change by audit. ANNUALLY. <br />DATE OF ISSUE: 06-29-15 WC ST ASSIGN: FL <br />OFFICE: FLORIDA WC JUA 821 <br />PRODUCER: VERO INSURANCE INC DBA 2374L Page 1 of 1 <br />